With a relentless focus on excellence in healthcare, Pullman Regional presents The Health Podcast.

Joey Wahler (Host): It's among the leading causes of death in the United States. So, we're discussing stroke awareness and care. Our guests are Dr. Aaron Scott, an emergency physician; Stephanie Knewbow, she's a registered nurse and also Emergency and Clinical Support Services Director, as well as Kim Johnson, who is also a registered nurse.

This is The Health Podcast from Pullman Regional Hospital. Thanks so much for joining us. I'm Joey Wahler. Hi, all. Welcome. Let's start with you, Dr. Scott. What exactly is a stroke? We've all heard the term, but what exactly does having a stroke mean, and what do its typical symptoms look like?

Dr. Aaron Scott: Well, a stroke is a sudden interruption of blood flow to the brain. Most of the time it's caused by a blockage in a brain blood vessel. Less frequently, it can be caused by bleeding in the brain. The interruption of the blood flow can partially or completely damage the part of the brain that is supplied.

Some strokes can be so small that they are difficult to recognize, while others can be deadly within minutes. Recognizing and treating strokes early is important because they are the fifth leading cause of death in the United States, and it is the leading cause of long-term disability. The symptoms of strokes can vary.

The formal definition is a sudden onset of a focal neurologic deficit. What this usually means is weakness or paralysis, typically of one side of the body, such as an arm or a leg or half of the face. Oftentimes, there's drooping or difficulty walking or weakness or clumsiness with that hand or arm. Also, common are problems with sensation or your body's ability to feel. This usually involves numbness. Most often on one side or one part of your body.

The other symptom we see frequently is difficulty speaking. Sometimes the patient doesn't recognize this in themselves, but this can look like stuttering or difficulty getting words out, or sometimes what we call word salad, which occurs when the patient's speech is basically gibberish or nonsense. And these strokes typically involve the speech part of our brain.

Less commonly, we can see difficulty with balance, such as stumbling or unsteadiness, vision problems such as double vision or difficulty seeing. And occasionally, people can have the sudden onset of a headache. But usually, strokes are painless.

We sometimes use a memory device called FAST or F-A-S-T. The F stands for face drooping, where one side of the face is just sagging compared to the other. The A is for arm weakness, where one arm just tends to droop more than the other, or you can't hold a cup or a glass. The S is for speech difficulties, either difficulty getting the speech out or what comes out doesn't make any sense. And the T stands for time. And the time means get to the emergency department as quickly as possible.

While this particular F-A-S-T device isn't perfect, it's worth remembering, putting on your refrigerator so you can recognize these in yourself and the people you care about. Many times, people don't recognize these symptoms in themselves, and it's up to friends and family to notice something is off. So basically, think of a stroke, whenever there's a sudden onset of weakness, numbness, or difficulty speaking, and call 911.

Host: Well, actually, that was going to be my next question. In view of what you just mentioned with the FAST acronym, Doctor, if someone recognizes those possible stroke signs, you said they should call 911. Anything else they should or shouldn't do in a nutshell?

Dr. Aaron Scott: Anything that results in a delay of getting to the emergency department. We have a very, very short window to treat this. And calling 911 or if you're literally across the street from the hospital, get to the emergency department as quickly as possible. What you probably shouldn't do is take any medications or eat anything.

Host: Understood. Understood. And when you mentioned time being of the essence, we're going to talk more about that in just a moment. Kim, for you, what is what's known as a code stroke, and what does that process entail once it is called?

Kim Johnson: A code stroke is really an emergency activation. It sets a whole cascade of events into place. We wear these walkie-talkies on our scrub tops in our facility. And so, actually, when you have a patient that presents like they're having a stroke or may be having a stroke, we can just push one button on it and alert our entire stroke team. So, that's really critical. If you had to do that, individually, it would waste a lot of time.

So when we do that, it sets a group of people into motion. We get, about 11 staff members that have an immediate response to the ER or wherever the stroke might be taking place. That would be five registered nurses, the emergency room physician, a tech from lab, two people from CT, respiratory therapy, and pharmacy.

And our goal there is really rapid determination of the patient's eligibility for other interventions. The CT is really the most critical aspect. We need the results of that CT to determine if the patient's eligible to go on to thrombectomy or to receive the clot-busting drug, tenecteplase. And any delay is just really detrimental. So, we do this just as fast and efficient as we can.

Host: And speaking of which, Kim, there's a saying regarding strokes that time is brain, to your point. So, what does that mean? For the layperson joining us, why is it so important to keep in mind that time is, literally, sometimes the difference between life and death, right?

Kim Johnson: Right. Well, in stroke, it's one of those super time-sensitive occurrences where every second that goes by that a portion of the brain is not getting perfused, it's causing brain death, cellular death. And I wish I had the exact number for you. But it's really fast and it's really detrimental. So literally, each minute that passes, the patient is losing brain function and years of their life. So, it's so critical that we do everything as practiced and seamless as we can so we can give them the best opportunity for a full recovery or the best recovery they can have.

Host: Absolutely. And Stephanie, how was the stroke program at Pullman Regional first created? Because you all have earned an important distinction that I'm going to ask you about in just a moment, but how did it all start?

Stephanie Knewbow: We created the stroke program after recognizing how time-sensitive stroke care is and how important it was for patients in our community to receive fast coordinated treatment as soon as they arrived at the hospital. We want our community to receive good stroke care even though we live in a rural area.

We worked with the emergency department, EMS, radiology, lab teams, and our providers, working together to build clear processes for quickly identifying strokes, getting patients over to the CAT scan, and starting treatment or arranging transfer when needed.

Since then, we've continued strengthening the program through staff education, case reviews, tracking response times, and making sure every team member understands their role during a code stroke activation. Our goal has always been to provide safe, efficient care, and improve outcomes for our patients.

Host: And so, obviously, it's a very well-planned out and choreographed, if you will, process when a stroke patient or a suspected stroke patient even is being attended to. So Stephanie, as I alluded to a moment ago, Pullman Regional has earned its fifth straight Acute Stroke-Ready recertification. So for those unfamiliar, what does stroke readiness mean, and what's it like for you and yours to again earn that important distinction?

Stephanie Knewbow: We are very happy to get it again for the fifth year. We have a strong stroke team that works on collecting our metrics throughout the year, and then reporting those to the DNV. And usually, stroke-ready is for hospitals that are in rural facilities, and it specifically says that we're equipped to immediately evaluate, stabilize, and treat sudden stroke symptoms. And kind of like I said before, it just shows that we, even living in a rural area, can give our community really good stroke care.

Host: And speaking of which, for you, Kim, in your view, what more than anything makes a strong stroke program, especially in a rural area like yours?

Kim Johnson: I'd have to say employee engagement would be the number one factor in making a great stroke program. We're really passionate about delivering high quality care, and there's a number of areas that really need time-sensitive treatment: STEMI, trauma, sepsis, and stroke. And that's just really fun to be able to make a difference in someone's life by training and getting proficient in this and delivering real high quality care. And I think we have staff that just are really on board with doing that.

It takes a lot of training, a lot of education, a lot of practice. You have to have the proper equipment. We spend a lot of time going over our data in stroke, seeing where we did really great and also seeing where we could make some improvements. Sometimes you'll find an area that's kind of a bottleneck and you can see you're losing some time there. We spend a lot of time on that and try to continuously improve. So, having employees that are on board with really feeling proud and striving to do a great job in these time-sensitive areas, and stroke's really, really that.

Host: Absolutely. Stephanie, couple of other questions for you all. First, what's been most rewarding for you about seeing the stroke program become what it is now? And what challenges would you say you and yours have overcome to get there, whether it be related to being in a rural area or otherwise?

Stephanie Knewbow: I think the most rewarding part has been watching the program grow into something that truly makes a difference for our patients and our community. Seeing the teamwork during a stroke activation and knowing that faster care can directly impact someone's outcome is incredibly rewarding. It's also been great to see how much confidence and collaboration have developed among the staff over time.

We have had some challenges. Building a consistent process across multiple departments takes a lot of communication and ongoing education. Stroke care moves very quickly, so making sure everyone is prepared and understands their role is important. We also had challenges that many smaller or rural hospitals face, like coordinating transfers, but those challenges have pushed us to keep improving and adapting.

Host: Yeah. It's really interesting to hear you all discuss all the pre-planning that goes on here so that when you all have to snap into action with little or no time to spare, you can do it as effectively as possible. So in summary, Dr. Scott, what's your message to the community and those joining us about why stroke awareness and stroke care are so important? I guess like many things in life, oftentimes people don't think about what a stroke involves until it hits them all of a sudden, right?

Dr. Aaron Scott: Yes. You know, I'm going to reiterate what I said before that stroke is the fifth leading cause of death. And I think, unfortunately, we all know what death means. But it's also the single leading cause of long-term disability in the United States. And almost everyone I know would rather live independently in their own home, cooking their meals, getting on with life. But too often, an incompletely or late treated stroke results in being in a nursing home or a long-term care facility or requiring assistance doing those things that you did without difficulty before. And that fact often motivates people to get this managed as quickly as possible.

What I'd also like to emphasize is the fact that the time window for treating a stroke is really short. It's even shorter than when treating heart attacks. Most people know to come to the emergency department when they're having chest pain to get evaluated for a heart attack, but they don't realize that a stroke is basically a "brain attack." And we have, under most circumstances, only four and a half hours from the onset of symptoms to administer brain-saving medications. So, it's even more urgent than heart attacks. That being said, heart attacks are urgent as well.

Each year, stroke care improves. There are more medications and interventions available. In some circumstances, we can administer medications that dissolve the blood clots that are causing the stroke, and we can also very quickly refer people to hospitals that provide something called endovascular therapy, where they can put a catheter in a blood vessel and literally suck out the blood clot that's causing the stroke. However, these treatments need to be administered as quickly as possible in order to work.

So, in summary, these treatments have been shown to reduce long-term disabilities such as weakness, difficulty speaking, numbness, and keeping you at home. And more people can return to independent living if they get timely stroke care.

Host: Yeah, no question. Reacting to patients having a stroke is really a whole world unto itself in the healthcare universe, and something that, as everyone has mentioned, certainly affects many people on a daily basis.

Well, folks, we trust you're now more familiar with stroke care at Pullman Regional Hospital. Thank you all so much. Appreciate it. Valuable information indeed. And for more information, please do visit pullmanregional.org/emergency. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler, and thanks so much again for being part of The Health Podcast from Pullman Regional Hospital.